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While Derrick Rose was tearing his ACL, I spent the morning conducting a 3D-Biomechanics Assessment on future projected Top Five NBA draft pick Shabazz Muhammad. While there are no guarantees the UCLA bound senior at Las Vegas’s Bishop Gorman High School will escape future knee injuries, the move will provide Muhammad with exercises targeting any weaknesses or imbalances in his body. The results are in the hands of Muhammad along with his current and future trainers at UCLA.

I appreciate the your coming out to do the tests on me,” said Shabazz. “I will do what I can to improve.” In addition, to the biomechanics assessment to identify his risk of injury, Shabazz, also was able to benefit from a fine tuning of his pelvis position during shooting free throws. Already with a free throw shooting percentage around 85%, after the adjustment to his pelvis, Shabazz stated, “I already feel myself shooting straighter.”

The subtle techniques changes will become permanent as Shabazz follows the strength and conditioning exercises and stretches recommended specifically for his body. But most importantly, Shabazz and other young players can significantly reduce the risk of overuse and compensatory injuries related to muscle imbalances.

For Derrick Rose, it’s not too late to help improve his ability to recover from his recent ACL tear. His recent injuries (prior to the ACL tear) were warning signs that something was about to go dreadfully wrong. It’s like ignoring the check engine or oil light in the car. Sure we can keep driving; check the oil and probably notice that we are low on oil (adding more), but eventually the symptom turns into a major problem. The light was an indicator that maybe we had an oil leak? I’m just guessing here but I’ve seen enough simple symptoms turn into major problems.

As for Rose, Oden, and others, to help us all understand the risks of rehab and recovery, let’s first gain a better understanding of the injury itself.

A tear to the anterior cruciate ligament (ACL) in the knee usually occurs in one of two ways: 1) hyperextension of the knee 2) rotation of the knee. Both causes contribute to ACL tears while bearing more weight on the knee than supporting muscles can bear. If either motion is too great, an ACL tear or meniscus tear (at a minimum) can occur. This type of non-contact injury usually occurs while the athlete is attempting to change directions. (There are other ways for injuries to occur but these are the two most common methods for non-contact related ACL/Meniscus tears).

Rose suffered a torn ACL while landing and attempting to RE-accelerate or change directions during his trademark “jump stop” power move. In my opinion, the injury occurred during the transition phase of the move where Rose was in between stopping and starting (changing directions). At the point in the game when the injury occurred, Rose’s body (which had spent the past two months compensating for injuries below the knee) was experiencing in-game fatigue. His ACL tear could have happened in the first minute or the last minute, however, because of his history.

Rose is and has always been a player who relies on his explosive leaping ability, quickness, and all around athletic ability. He has been labeled a fearless player who plays with reckless abandon. That all changed with a little over one minute to play in game one of the 2012 playoffs against the Philadelphia 76ers.

How will this affect Rose going forward?

In the future, when Rose moves to his right, he will be able to play aggressively. However, stopping or changing directions while moving to the right will be extremely challenging. As Rose attempts to change directions while moving to the right, the inside of the left knee must assist in deceleration. If the left leg does not absorb its appropriate share of the workload during this deceleration, one of two things is bound to happen: 1) re-injury to the left knee or 2) new injury to the right knee.

As Rose attempts to move to the left, the outside of the left knee absorbs the majority of the workload while moving in that direction. This creates less of a challenge for Rose in the future because of the nature of the injury. Stopping or changing directions for Rose when moving left should be considerably easier for Rose to do as the inside of his right knee will bear the majority of the load in deceleration. The act of actually pushing off is primarily the responsibility of the outside of his left leg. As a result, Rose will be able to change directions when moving left, but may subconsciously rely more on his right leg.

In my description above, Rose will be forced to overuse his right leg considerably, resulting in a higher risk of injury to the right leg from foot to hip. We may see Rose tear his right ACL or retear his left, develop Patella tendonitis in the right knee, or suffer an injury to the right hip,or foot (which was supported by muscles already weaker than those in his left leg).

The biggest concern for Rose is the fact that Rose’s injury is an injury related to rotational stability of his left knee. The ACL attaches to the inside of the lateral aspect of his femur (thigh bone) and the lateral aspect of the medial portion of the tibia (lower leg). In stabilizing the knee, the ACL resists rotation. In Rose’s case, his lower leg internally rotated and could not stabilize before his femur began to externally rotate. The rotated out of sequence and in opposite directions.

The most neglected part of ACL surgery and rehab is the rotational stability of the knee. During surgery, the bones of the upper and lower leg are not typically rotated back into their normal position prior to the injury. The new ACL is attached typically with the two segments in the posture they moved to when the injury occurred.

As for rehab, we constantly hear “experts” in the field of medicine and rehab referring to the quadriceps and hamstring muscles as the most important to ACL recovery. But we are rehabbing only part of the knee’s stabilizing muscle groups.

Why is it that no one discusses the extremely important segment of the body below the knee with muscles that cross the knee and assist in the stability of the knee? It’s because the protocols have become watered down and we only look at the primary muscles that flex or extend the knee. Apparently, experts in the field of rehab and medicine have forgotten that the lower leg muscles assist in stabilizing and supporting healthy knee function. Yes, I’m referring the entire muscle group of the lower leg.

The Gastrocnemius/Soleus complex (typically referred to as the calf muscles) is the single most important muscle group to target when recovering from ACL surgery, the quads and hamstrings are important but no more important than the lower leg muscle group. Yet, only a minimal portion rehab is dedicated to targeting the lower leg. The Anterior and Posterior Tibialis, and mobility of the peroneals are extremely important to complete recovery.

In addressing this area to aid in recovery, Rose’s therapist must pay attention to the rotation of the knee, by manually assisting the repositioning the tibia/femur posture. In doing so, they can return his knee to its pre-injury “joint posture”. If this happens, Rose can return quickly and achieve near pre-injury levels, reducing his risk of re-occurrence.

If you ask anyone who has ever undergone ACL or meniscus rehab (Greg Oden, Brandon Roy, Terrell Owens, myself (8 times), and the list goes on and on) no one will say that they spent a good deal of rehab time working on developing the lower leg muscles. For Derrick Rose and others to recover completely from ACL or other knee injuries, more emphasis must be placed on the lower leg. If not, Rose will become an out of control player (unable to stop to change directions) or suffer repeated injuries to his knees and be out of the game before he’s 26 years old. Keep in mind that rehab type exercises for Rose will need to become a part of his regular training program to ensure that his “fixes” are permanent and to keep him from suffering chronic knee, hip, foot, and other injuries. As a Bulls fan, I’m pulling hard for Derrick Rose, but I have my concerns.

As a Sports Kinesiologist specializing in human movement, I’m pulling for experts in our field to open their eyes and close their protocols. Address every athlete individually, not the injury. The injury is just a symptom that something went wrong. And in the case of Derrick Rose, Greg Oden, Brandon Roy and others, something went wrong repeatedly and will continue to do so, unless the root cause of the injury is address. Let’s hope Shabazz Muhammad and other young players bound for the NBA can benefit from the changes in the sports, fitness, and medical injury early enough to stop the trend in accepting injuries as part of the game. Many injuries can be prevented but we have to take steps to make this a reality.

Zig Ziegler, The Sports Kinesiologist, provides feedback on injuries to A-List athletes in an effort to help educate athletes and parents on the prevention of injuries. Be sure to check out other stories here about Greg Oden, Brandon Roy, Mark Sanchez, Tiger Woods, and more. Follow Zig on twitter @zig_ziegler.

18 thoughts on “Derrick Rose Update: Career in Jeopardy…Why Rose will never be the same!”

I found your site after reading the Grantland piece on Greg Oden, which linked to your long article. Fascinating stuff.

My question for you, as I’m sure most of your readers aren’t professional athletes, is how kind of intelligent/scientific approach could help a weekend warrior like me? I play golf, basketball, soccer, softball, etc. and want to be able to do all of these things well into my future and with my kids. Are there things I can do to make sure I’m not putting myself in jeopardy? I have a history of sports injuries (knee and ankle, but nothing as serious as ligament damage or broken bones) and wonder if I can help myself down the road.

There are many things you can do but I’d hate to offer advice without knowing more. I can tell you that it is important to improve the function of your ankle or more problems may occur. You could experience back and/or neck pain as a result of a poorly functioning ankle as well as other joint or muscle issues and these will definitely affect your quality of life. Stay tuned And I’ll see what I can do to help you and others with tips and advice on my new website.

What sort of exercises should one do to strengthen the lower leg? If one were to strengthen these muscles, would it reduce the risk of an ACL injury or an injury to leg in general?

I ask, because I had some tendonitis in my knee as well as a unidentified lateral meniscus injury in my right knee, after it absorbed an accidental kick while playing basketball. There was pain on the outside of the knee and a tightening every time I flexed it (as when one stretches one’s quads). I have since done some rehab on it, working more on the quads and hamstrings, and not so much with the calf.

If I were to strengthen those muscles would the injury itself improve? It’s diminished mostly, though there is an occasional pinch in the outside the knee during some form of exertion (running, etc.). I worry, especially after seeing all of these ACL tears (Mariano Rivera, Iman Schumpert, Derrick Rose and such), that not treating this injury properly may cause me to compensate for the weakness and can cause a far worse injury.

I love the blog, and though there are those that want to rip apart your work, I think it’s great. Hell, if people don’t like it, they don’t have to read it. Keep it up!

The most common exercise you can do to strengthen the lower leg is calf raises (to be done both bent leg-90 degrees and straight leg–not hyperextended. The key in performing any exercise is how you do it. Please keep exercise technique in mind. It is more important to do any exercise correctly rather than just doing the exercise, as poor technique may lead to more problems. the lower leg muscles are the shock absorber for your knees closest to the knees. It is often touched upon then neglected during rehab. They are also shock absorbers when you run so weak lower leg muscles can lead to pain during running. There are many other exercises for the lower leg to be considered not just calf raises. Thank you for the support and compliment. It is for people like you that I write and work in the field.

Great question Xavier. I underwent 8 surgeries as an athlete not as a result of my own work (like other athletes I have had many injuries). Just like other athletes, I too went to therapy. But my first surgery was in college while I was learning. My last surgery was over 15 years ago. And since then I have committed myself to helping other athletes prevent a similar fate. I hope that helps answer your question. Remember, no one person is perfect in their efforts. It is a process, but we should be striving towards perfection. Would you agree? No one sets out to fail an exam or injure themselves. Sometimes the injury occurs as the result of our own actions, other times as the result of the lack of action by others. All the best to you!

As a fellow Bulls fan, I BEG that you contact the organization or someone with this information. And while there seemed to be some doom and gloom in this article, is it still possible he looks like old in 2 years??

Hello, i love the article , you are very passionate and very knowledgeable in what you do. I am a basketball player who is currently chasing a dream of playing pro ball overseas. Recently I’ve had bumps in the road dealing with patellar tendonitis, the pain accurs on both knees in the same exact spot just below the kneecap towards the medial side. I’ve tried therapy and it’s helped but as soon as I come back the pain comes back, what I notice is my knee caps kind of face lateral when I’m sitting in a chair also when sitting down my hip has some pain if I try to pull my knees medialy , and when I do squats the rotation of my upper legs wants to go laterally ? I don’t kno if any of this helps or if you could give me any tips on rehab or what I can do, my calfs and quads are very strong and defined so the therapist didn’t think we had a problem there , anyway I hope you read this and could help in anyway possible thankyou

Good morning. Your question was pulled from the spam filter where it has sat since you posted. I wanted to see if I could help ease your pain.

If your pain has not subsided, can you send a video of yourself squatting? Just perform 5 simple squats (no weight necessary). This is just a body weight squat. The video should be clear enough for me to see your feet, knees, and hip. If you can have a friend shoot the video with your cell phone and email it, that would be great. I will not post your video as part of my reply. If need be you may send it to me on twitter. Thank you and my apologies for the delay.

Hi, I saw that you mentioned how back problems are related to ankle injuries, and I am very interested, as I’m going through various back problems (SI joint dysfunction, piriformis syndrome) and I feel way too young to be struggling with this. I sprained my ankle about a year ago and feel like I never properly rehabbed it, and although I can jump higher than ever, as soon as I’m done working out my back is killing me, and while I get into defensive stance for basketball, my groin is extremely inflexible and painful. If this is indeed related to the ankle, are there any tips you have for rehabbing this late?

Hi. Thanks for the comment. I would love to help but need more information. Pictures are helpful. If you can have someone take a pic of you from the ground up. Closeup shots of the ankle to hip are helpful on both sides. I look forward to hearing back from you. You may email them me at my address on the blog or post them in your response. All the best!

Zig is a wizard. A year and a half later, Derrick Rose has torn his MCL in his right knee, and his career seems all about finished in terms of being a top 5, or even top 20 NBA player. Bulls training staff could have benefited from this man’s knowledge.